{
  "schema_version": 1,
  "kind": "condition",
  "id": "episcleritis",
  "name": "Episcleritis (simple & nodular)",
  "category": "chronic",
  "sources": "Ketorolac tromethamine ophthalmic solution 0.5% US prescribing information, section 2 Dosage and Administration (DailyMed SetID d9a186ba-74a9-b6d4-1109-1e045ba1763e) · FML Liquifilm (fluorometholone 1 mg/mL) eye drops SmPC sections 4.2 and 4.4 (eMC product 1383) · Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt) · Ibuprofen 400 mg film-coated tablets (POM) SmPC sections 4.3 and 4.4 (eMC product 7020)",
  "review_status": "reviewed",
  "verified_against": "Ketorolac tromethamine ophthalmic solution 0.5% US prescribing information, section 2 Dosage and Administration (DailyMed SetID d9a186ba-74a9-b6d4-1109-1e045ba1763e) · FML Liquifilm (fluorometholone 1 mg/mL) eye drops SmPC sections 4.2 and 4.4 (eMC product 1383) · Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt) · Ibuprofen 400 mg film-coated tablets (POM) SmPC sections 4.3 and 4.4 (eMC product 7020)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 667,
      "generic": "Sodium hyaluronate",
      "line": 1,
      "is_adjunct": false,
      "form": "eye",
      "strength_mg": null,
      "adult_dose": "Instil 1 drop into the affected eye at least four times daily. Keeping the bottle in the fridge adds to the relief - the article's recommendation is refrigerated artificial tears.",
      "adult_duration": "Until it settles - most episcleritis resolves within 2 to 21 days",
      "dose_source": "Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt)",
      "rationale": "Mild, self-limiting episcleritis responds well to supportive ocular lubrication",
      "cautions": [
        "No licensed ophthalmic dose exists for this drug to quote. The UK and US regulate ocular hyaluronate as a device rather than a medicine, and the only medicine label under the name is the intra-articular injection - a different route entirely. The frequency here is the disease article's recommendation for artificial tears in episcleritis, and this drop is one of that class.",
        "Differentiate from TRUE SCLERITIS (scleritis causes deep severe boring eye pain, bluish scleral hue, and threatens vision; requires urgent ophthalmology referral).",
        "Phenylephrine 2.5% drop causes blanching of episcleral vessels but not deep scleral vessels."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Same as the adult: 1 drop at least four times daily. A surface lubricant has no weight-based dose.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "LUBRIVISC 0.1% EYE DROPS 10 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "RAMEDA > HIKMA PHARMA",
          "price_egp": 32.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "HYALUGRAND 0.2% EYE DROPS 10 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "DELTA GRAND PHARMA",
          "price_egp": 41.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "HYALOPTIC 0.2% EYE DROPS 10 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHARCO",
          "price_egp": 48.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "HYFRESH 0.2% EYE DROPS 10 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "JAMJOOM PHARMACEUTICALS",
          "price_egp": 75.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "XILOIAL MONO EYE DROPS 20 RE-CLOSABLE VIALS * 0.5 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "FARMIGEA > HABIB SCIENTIFIC OFFICE",
          "price_egp": 265.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VISMED MULTI 0.18% EYE DROPS 10 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "TRB CHEMEDICA SA > RHEUMA",
          "price_egp": 335.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VISMED MULTI 0.3% EYE GEL 10 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "TRB CHEMEDICA SA > RHEUMA",
          "price_egp": 390.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "AQUALARM INTENSIVE UD EYE DROPS 30 X 0.5ML SDU",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "BAUSCH AND LOMB",
          "price_egp": 425.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "episcleritis"
    },
    {
      "id": 668,
      "generic": "Fluorometholone",
      "line": 2,
      "is_adjunct": false,
      "form": "eye",
      "strength_mg": null,
      "adult_dose": "Instill 0.1% ophthalmic suspension 1 drop 4 times daily for 7 days under ophthalmologist guidance",
      "adult_duration": "7 days",
      "dose_source": "FML Liquifilm (fluorometholone 1 mg/mL) eye drops SmPC sections 4.2 and 4.4 (eMC product 1383)",
      "rationale": "Soft topical corticosteroid for moderate-to-severe discomfort unresponsive to artificial tears",
      "cautions": [
        "Ophthalmic steroids MUST NOT be prescribed without slit-lamp examination to rule out herpes simplex keratitis.",
        "There is a risk of intraocular pressure spike, glaucoma, and cataract formation with extended use.",
        "A week is the limit without an eye specialist watching and measuring the pressure. Past that, steroid drops raise intraocular pressure, cut the optic nerve, and build a posterior subcapsular cataract.",
        "A history of herpes simplex keratitis demands great caution - a steroid on a dendritic ulcer is how a cornea perforates. Slit lamp before and during.",
        "It masks an untreated eye infection and can make it worse. Be sure what you are treating first.",
        "In a chronic case do not stop dead - taper the frequency down."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Ophthalmologist prescription only in children",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "FLUMETOL S 0.1% STERILE EYE DROPS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "KAHIRA",
          "price_egp": 3.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "SWIXFLUR S 0.1% EYE DROPS 5 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "CHEMIPHARM",
          "price_egp": 3.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FML LIQUIFILM 0.1% EYE DROPS 5 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO > ALLERGAN",
          "price_egp": 5.55,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FLUCON 0.1% EYE DROPS 5 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "NOVARTIS > NOVARTIS SCIENTIFIC OFFICE",
          "price_egp": 12.6,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "episcleritis"
    },
    {
      "id": 669,
      "generic": "Ketorolac tromethamine",
      "line": 2,
      "is_adjunct": false,
      "form": "eye",
      "strength_mg": null,
      "adult_dose": "Instill 0.5% ophthalmic solution 1 drop 4 times daily",
      "adult_duration": "7-10 days",
      "dose_source": "Ketorolac tromethamine ophthalmic solution 0.5% US prescribing information, section 2 Dosage and Administration (DailyMed SetID d9a186ba-74a9-b6d4-1109-1e045ba1763e)",
      "rationale": "Topical NSAID alternative avoiding corticosteroid-induced intraocular pressure spikes",
      "cautions": [
        "There is a rare risk of corneal melting with prolonged topical NSAID use.",
        "No contact lenses while these drops are in use.",
        "Topical NSAIDs slow healing of the ocular surface, so keep the course short and stop if the eye gets worse rather than better - that is how corneal thinning starts.",
        "The label covers allergic conjunctivitis and post-cataract inflammation. Episcleritis is outside it: a reasonable use, but an off-label one.",
        "Transient ocular burning or stinging can occur upon instillation."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Child >=2 years: 1 drop 4 times daily for 7 days",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": [
        {
          "label": "2 years and over",
          "age_min_months": 24,
          "age_max_months": 216,
          "dose_text": "1 drop into affected eye 4 times daily for 7 days."
        }
      ],
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "KETOROLAC 0.5% EYE DROPS 5 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEMPHIS",
          "price_egp": 6.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "KETOROLIN 0.5% EYE DROPS 15 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHAROPHARMA",
          "price_egp": 16.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "POLYOTHALMIC 5MG/ML EYE DROPS 5 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "DELTA GRAND PHARMA",
          "price_egp": 5.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 5.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "SAMULGIN 0.5GM/100ML EYE DROPS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "AMOUN",
          "price_egp": 8.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FAM 5MG/ML EYE DROPS 5 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ALFACURE PHARMACEUTICALS",
          "price_egp": 9.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 5.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ACULAR LS 0.4% EYE DROPS 5 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ALLERGAN > SOFICOPHARM",
          "price_egp": 41.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "episcleritis"
    },
    {
      "id": 670,
      "generic": "Ibuprofen",
      "line": 2,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": null,
      "adult_dose": "200 to 600 mg 3 to 4 times per day",
      "adult_duration": "up to two weeks",
      "dose_source": "Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt) for the indication; the paediatric dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): \"Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)\", which the eye article does not carry.",
      "rationale": "Oral NSAID option for episcleritis as an alternative to topical steroids.",
      "cautions": [
        "CONTRAINDICATED, UK label verbatim (Ibuprofen 400 mg film-coated tablets, section 4.3): \"severe renal failure or severe hepatic failure\" (<meta name=\"description\" content=\"Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020); \"active, or history of recurrent peptic ulcer/haemorrhage\" (<meta name=\"description\" content=\"Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020); \"significant dehydration (caused by vomiting, diarrhoea or insufficient fluid intake)\" (<meta name=\"description\" content=\"Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020); \"last trimester of pregnancy\" (<meta name=\"description\" content=\"Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020); and \"previous hypersensitivity reactions (e.g. asthma, rhinitis, urticaria or angioedema) in response to acetylsalicylic acid or other NSAIDs\" (<meta name=\"description\" content=\"Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020). Section 4.4 adds special care in \"Reduced renal function\" (<meta name=\"description\" content=\"Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020), \"Hepatic dysfunction\" (<meta name=\"description\" content=\"Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020) and \"chronic obstructive airway disease or bronchial asthma\" (<meta name=\"description\" content=\"Ibuprofen 400 mg film-coated tablets (POM) SmPC, eMC product 7020) - so ordinary asthma and lesser renal impairment are a caution, not a bar.",
        "Do not give an NSAID in suspected chickenpox or dengue - both can present with fever, and both raise serious risk.",
        "With food. In a child aged 3-5 months seek advice if symptoms last beyond 24 hours."
      ],
      "peds_mgkg_low": 5.0,
      "peds_mgkg_high": 10.0,
      "peds_max_mg": 400.0,
      "peds_basis": "dose",
      "peds_unit": "mg",
      "peds_note": "Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily).",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": [
        {
          "weight_kg": 10,
          "low_mg": 50,
          "high_mg": 100,
          "capped": false
        },
        {
          "weight_kg": 20,
          "low_mg": 100,
          "high_mg": 200,
          "capped": false
        },
        {
          "weight_kg": 30,
          "low_mg": 150,
          "high_mg": 300,
          "capped": false
        },
        {
          "weight_kg": 40,
          "low_mg": 200,
          "high_mg": 400,
          "capped": false
        }
      ],
      "brands": [
        {
          "trade_name": "DAJUANOFEN 200 MG 20 CAPS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "COPAD PHARMA",
          "price_egp": 4.0,
          "pack_count": 20,
          "unit_price": 0.2,
          "strength_mg": 200.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "DAJUANOFEN 400 MG 20 F.C. TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "COPAD PHARMA",
          "price_egp": 5.0,
          "pack_count": 20,
          "unit_price": 0.25,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "NOVA-PROFEN 200MG 30 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SANOFI",
          "price_egp": 9.0,
          "pack_count": 30,
          "unit_price": 0.3,
          "strength_mg": 200.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "MARCOFEN 400 MG SR 10 CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLAXO SMITHKLINE",
          "price_egp": 5.85,
          "pack_count": 10,
          "unit_price": 0.58,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "MAFO 400 MG  30 F.C.TABS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 42.0,
          "pack_count": 30,
          "unit_price": 1.4,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FLAMOTAL 800 MG 10 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > FUTURE PHARMACEUTICAL INDUSTRIES (FPI)",
          "price_egp": 35.0,
          "pack_count": 10,
          "unit_price": 3.5,
          "strength_mg": 800.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "BRUFEN 600 MG 20 EFF. GR. IN SACHETS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "KAHIRA > ABBOTT LABORATORIES",
          "price_egp": 120.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 600.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "SPIDIDOL 600 MG 12 EFF. GR. IN SACHETS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ZAMBON > PHARMACON",
          "price_egp": 132.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 600.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "NOVA-PROFEN  100MG/5ML ORAL SUSP. 100ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SANOFI",
          "price_egp": 2.25,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 100.0,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "BRUFEMOL-N SUSP. 60 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ARAB DRUG COMPANY (ADCO)",
          "price_egp": 4.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "episcleritis"
    },
    {
      "id": 671,
      "generic": "Naproxen",
      "line": 2,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": null,
      "adult_dose": "250 to 500 mg twice per day",
      "adult_duration": "up to two weeks",
      "dose_source": "Episcleritis (simple & nodular) - disease-level clinical article (episcleritis-clinical.txt)",
      "rationale": "Oral NSAID option for episcleritis as an alternative to topical steroids.",
      "cautions": [
        "Co-prescribe PPI gastroprotection for continuous long-term use.",
        "Urgent rheumatology referral is required for biologic disease-modifying anti-rheumatic drugs (TNF inhibitors / IL-17 inhibitors).",
        "Co-prescribe PPI in elderly or ulcer-prone patients."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Naproxen is not recommended for use in any other indication in children under 16 years of age. That sentence is the Naproxen 500mg Tablets SmPC section 4.2, verbatim.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "NAPROFEN 250MG 10 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EL NILE.",
          "price_egp": 3.65,
          "pack_count": 10,
          "unit_price": 0.36,
          "strength_mg": 250.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
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}